Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China.
College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
Front Cell Infect Microbiol. 2022 Jun 27;12:899845. doi: 10.3389/fcimb.2022.899845. eCollection 2022.
Meta-analysis of randomized clinical trials (RCT) demonstrated several health benefits of fecal microbiota transplantation (FMT). However, there has been little comprehensive assessment of the strength and quality of evidence. We conducted an umbrella review to summarize the evidence of the association between FMT and health outcomes.
PubMed, Embase, and Cochrane library databases were searched from inception to August 6, 2021. The random-effects model was applied to recalculate the effect estimates. We used AMSTAR 2 and GRADE to assess the methodological quality and to grade the evidence.
A total of 7 meta-analyses comprising 26 RCTs (median [IQR] primary study, 6 [2-7]; median [IQR] sample size, 267 [147-431] participants) were included in the current umbrella review describing 45 unique associations. There were 22 statistically significant associations (49%) demonstrating beneficial outcomes of FMT for antibiotic resistance burden, functional constipation, inflammatory bowel disease, and C. difficile infection. FMT does not appear to be associated with positive outcomes in irritable bowel syndrome and metabolic syndrome. Eight significant associations (36%) were supported by moderate-quality evidence, nine associations (41%) were supported by low-quality evidence, and the remaining associations found to be significant were supported by very low-quality evidence.
Although we found that FMT was positively associated with several outcomes, caution should be exercised in choosing this approach, given the insufficient number of primary studies, low methodological quality, and low quality of evidence. Further high-quality randomized controlled trials with long-term follow-up are needed to improve the strength and credibility of the evidence base.
随机临床试验（RCT）的荟萃分析显示粪便微生物群移植（FMT）有多种健康益处。然而，对于证据的强度和质量几乎没有全面评估。我们进行了伞式综述，以总结 FMT 与健康结果之间关联的证据。
从建库到 2021 年 8 月 6 日，我们在 PubMed、Embase 和 Cochrane 图书馆数据库中进行了检索。应用随机效应模型重新计算效应估计值。我们使用 AMSTAR 2 和 GRADE 评估方法学质量，并对证据进行分级。
本伞式综述共纳入 7 项荟萃分析，包含 26 项 RCT（中位数 [IQR] 主要研究，6 [2-7]；中位数 [IQR] 样本量，267 [147-431] 名参与者），共描述了 45 种独特的关联。有 22 种具有统计学意义的关联（49%）表明 FMT 对抗生素耐药负担、功能性便秘、炎症性肠病和艰难梭菌感染有有益的结果。FMT 似乎与肠易激综合征和代谢综合征的阳性结果无关。8 种具有统计学意义的关联（36%）得到了中等质量证据的支持，9 种关联（41%）得到了低质量证据的支持，其余被发现有统计学意义的关联则得到了极低质量证据的支持。
尽管我们发现 FMT 与多种结果呈正相关，但鉴于初级研究数量不足、方法学质量低和证据质量低，在选择这种方法时应谨慎。需要进一步开展高质量、长期随访的随机对照试验，以提高证据基础的强度和可信度。
